NPI | 1922742980 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6851114072) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851114072) |
Enumeration Date | 2022-04-26 |
Last Update Date | 2022-05-03 |